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Right Heart Dilatation in Adults: Congenital Causes

¹ Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC.
² Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710.
³ Duke Cardiovascular Magnetic Resonance Center and Duke University Medical Center, Durham, NC.
⁴ Department of Medicine, Division of Adult Cardiology, Duke University Medical Center, Durham, NC.

Received November 30, 2006; accepted after revision April 23, 2007.

 
Address correspondence to L. M. Hurwitz (hurwi001{at}mc.duke.edu).

Abstract

Top Abstract Introduction Atrial Septal Anatomy and... Partially Anomalous Pulmonary... Coronary Artery Fistulas Tricuspid Valve Abnormalities Pulmonary Valve Myocardium Conclusion References

 
OBJECTIVE. The purpose of this article is to illustrate the common congenital cardiac lesions that are characterized by right-sided heart enlargement that may be seen on routine thoracic or cardiac imaging.

CONCLUSION. A systematic approach to the evaluation of the right heart and an understanding of the congenital abnormalities causing right chamber enlargement will allow the radiologist to diagnose unsuspected cardiac abnormalities on routine clinical thoracic and cardiac imaging as well as accurately identify these defects on dedicated cardiac CT or MRI examinations.

Keywords: cardiac imaging • chest radiography • congenital cardiac anomalies • CT • heart • MRI • right heart

Introduction

Top Abstract Introduction Atrial Septal Anatomy and... Partially Anomalous Pulmonary... Coronary Artery Fistulas Tricuspid Valve Abnormalities Pulmonary Valve Myocardium Conclusion References

 
Although most congenital heart defects are diagnosed during early childhood, several of these structural abnormalities, particularly those that are not associated with cyanosis, may not be detected until later in childhood or in adulthood because of a lack of clinical symptoms or the subtlety of the abnormalities detected on physical examination. Left-to-right shunts can be divided into pretricuspid and posttricuspid shunts. The former dilate the right heart, whereas the latter dilate the left heart. In addition, structural anomalies of the right-sided valves and the myocardium may cause enlargement of the right heart chambers. In this article, we describe the more common congenital lesions that present with predominantly right-sided chamber enlargement.

Although echocardiography is the standard for the diagnosis and assessment of the cardiac chambers, morphologic and functional information of the right ventricle may be inadequately assessed using echocardiography because of the complex shape of the right ventricle and the poor acoustic windows commonly present in adults. The first signs of asymptomatic right-sided heart disease may be detected on chest radiography, CT, or MRI.

On a posteroanterior chest radiograph, the right ventricle is normally not a border-forming structure. Signs of right ventricular dilatation on this view include dilatation of the pulmonary trunk, increased convexity of the left upper cardiac contour, and an upturned cardiac apex [1]. On the lateral view, the right ventricle enlarges superiorly and anteriorly behind the sternum. The right atrium is considered enlarged when the right aspect of the cardiac silhouette on the posteroanterior chest radiograph enlarges. For adults, extension of the right heart border 5 cm or greater from the midline on the posteroanterior projection is considered suggestive of right atrial enlargement [1].

Assessment of the right heart chambers on routine CT and MRI has limitations because the true axis of the heart lies obliquely in the thorax and varies for each patient. Echocardiographic data suggest that the size of a normal right ventricle ranges from 2.2 to 4.4 cm in maximum diameter and that the size of a normal right atrium ranges from 3.0 to 4.6 cm in the apical four-chamber view [2]. As a ratio, echocardiographic data suggest that the right ventricle and the right atrium tend to be similar or smaller (in size) in cross-sectional diameter than the left ventricle and the left atrium, respectively [2]. In addition to chamber enlargement on axial CT and MR images of the thorax, findings of right ventricular enlargement include rotation of the heart to the left with the right ventricle positioned more anteriorly in the thorax behind the sternum as described on chest radiographs [1].

Cardiac MRI has shown both accuracy and reproducibility in the estimation of right ventricular volume [3-5]. The right ventricle is judged as dilated on the basis of normal ranges specific to body surface area and sex via images obtained using turbo gradient-echo and steady-state free precession techniques [6]. In addition, intracardiac shunts and insufficiency fractions can be accurately quantified on MRI. Cardiac MDCT has shown comparable quantification of right ventricular volumes and ejection fractions when compared with MRI as the gold standard [7].

A systemic approach to evaluating enlargement of the right heart chambers will help accurately localize a cardiac lesion if it is the cause of right heart enlargement. Appendix 1 lists the more common congenital heart abnormalities that result in right chamber enlargement. These abnormalities may be located at the level of the atrial septum, tricuspid valve, pulmonary valve or may be isolated to the myocardium.

APPENDIX 1: Most Common Congenital Causes of Right Heart Dilatation in Adults

1. Pretricuspid left-to-right shunts     Atrial septal defects (ASDs)         A. Primum ASD         B. Secundum ASDa         C. Sinus venosus septal defect         D. Coronary sinus septal defect     Partially anomalous pulmonary venous connectiona     Systemic arteriovenous malformation     Coronary cameral fistula to the right atrium     Coronary artery fistula to the coronary sinus     Gerbode defect (left ventricle-to-right atrial shunt) 2. Posttricuspid left-to-right shunts     Coronary cameral fistula to the right ventricle     Sinus of Valsalva fistula to right ventricle 3. Tricuspid valve regurgitation     Dysplastic valve     Ebstein's anomalya     Postsurgical—recurrent, iatrognic, or residual 4. Myocardium     Uhl's anomaly     Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) 5. Pulmonary valve regurgitation     Dysplastic valve     Postsurgical repair of right ventricular outflow tract obstruction (e.g., tetralogy of Fallot)a

^a More common causes.

Atrial Septal Anatomy and Atrial Level Defects

Top Abstract Introduction Atrial Septal Anatomy and... Partially Anomalous Pulmonary... Coronary Artery Fistulas Tricuspid Valve Abnormalities Pulmonary Valve Myocardium Conclusion References

 
For precise anatomic diagnosis of an atrial septal defect (ASD), one must understand the anatomy of the atrial septum and be able to describe the defect in relationship to the surrounding structures [8] (Fig. 1). Classically, an ASD will result in enlargement of the right atrium and the right ventricle. Shunt vascularity may also be noted on chest radiography, depending on the degree of left-to-right shunting (Fig. 2A, 2B, 2C, 2D, 2E, 2F). ASDs are classified as secundum atrial septal defects if they are located at the middle of the atrial septum within the fossa ovalis (Fig. 2A, 2B, 2C, 2D, 2E, 2F), and defects contiguous with atrioventricular valves are described as primum atrial septal defects (partial atrioventricular canal defects) (Fig. 3A, 3B). Of the intracardiac shunts located at the atrial level, a secundum ASD is the most common to be identified during late childhood or early adulthood. A primum ASD is a much rarer congenital heart defect. Distinguishing between a secundum ASD and a primum ASD has implications for treatment because a secundum ASD may sometimes be closed through a percutaneous approach, whereas a primum ASD always requires surgical closure.

View larger version (74K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Diagram shows atrial septum and atrial septal defects (ASDs). In this view, free right atrial wall has been removed. R. = right. (Courtesy of Michael Stevens, Winston-Salem, NC)

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —48-year-old asymptomatic man with secundum atrial septal defect (ASD). Posteroanterior (A) and lateral (B) chest radiographs show shunt vascularity (arrows, A) with normal-sized cardiac silhouette.

View larger version (110K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —48-year-old asymptomatic man with secundum atrial septal defect (ASD). Posteroanterior (A) and lateral (B) chest radiographs show shunt vascularity (arrows, A) with normal-sized cardiac silhouette.

View larger version (95K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —48-year-old asymptomatic man with secundum atrial septal defect (ASD). Contrast-enhanced axial CT images of heart obtained from abdominal CT reveal enlargement of right ventricle (RV). LV = left ventricle.

View larger version (100K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —48-year-old asymptomatic man with secundum atrial septal defect (ASD). Contrast-enhanced axial CT images of heart obtained from abdominal CT reveal enlargement of right ventricle (RV). LV = left ventricle.

View larger version (150K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2E —48-year-old asymptomatic man with secundum atrial septal defect (ASD). Still images from cine MRI four-chamber (E) and short-axis (F) views of heart show large secundum ASD (arrow). RV = right ventricle, LV = left ventricle, RA = right atrium, LA = left atrium.

View larger version (157K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2F —48-year-old asymptomatic man with secundum atrial septal defect (ASD). Still images from cine MRI four-chamber (E) and short-axis (F) views of heart show large secundum ASD (arrow). RV = right ventricle, LV = left ventricle, RA = right atrium, LA = left atrium.

View larger version (160K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —19-year-old woman with complaints of chest discomfort with exertion. Still images from cine MRI four-chamber (A) and short-axis (B) views of heart show communication (arrow) between left atrium (LA) and right atrium (RA) just above level of left atrioventricular valve consistent with primum atrial septal defect. RV = right ventricle, LV = left ventricle.

View larger version (167K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —19-year-old woman with complaints of chest discomfort with exertion. Still images from cine MRI four-chamber (A) and short-axis (B) views of heart show communication (arrow) between left atrium (LA) and right atrium (RA) just above level of left atrioventricular valve consistent with primum atrial septal defect. RV = right ventricle, LV = left ventricle.

View larger version (170K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —58-year-old woman with symptoms of increasing dyspnea. Still image from cine MRI four-chamber view of heart shows enlargement of right atrium (RA) and right ventricle (RV). LV = left ventricle, LA = left atrium.

View larger version (169K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —58-year-old woman with symptoms of increasing dyspnea. Bright blood axial image shows direct communication (arrow) between superior vena cava (asterisk), right upper lobe pulmonary veins, and left atrium (LA) consistent with sinus venosus defect. AA = ascending aorta.

View larger version (170K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —58-year-old woman with symptoms of increasing dyspnea. Dark blood axial image from different patient with same diagnosis shows direct communication (arrow) between superior vena cava (asterisk) and left atrium (LA) consistent with sinus venosus defect. AA = ascending aorta.

View larger version (86K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —65-year-old woman with history of breast cancer and persistent complaints of dyspnea. Axial contrast-enhanced images of chest show enlargement of right atrium (RA), right ventricle (RV), and coronary sinus (asterisk, B). LA = left atrium, LV = left ventricle.

View larger version (108K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —65-year-old woman with history of breast cancer and persistent complaints of dyspnea. Axial contrast-enhanced images of chest show enlargement of right atrium (RA), right ventricle (RV), and coronary sinus (asterisk, B). LA = left atrium, LV = left ventricle.

View larger version (162K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —65-year-old woman with history of breast cancer and persistent complaints of dyspnea. Still images from cine MRI four-chamber (C and D) and short-axis (E and F) views of heart show enlarged right atrium (RA) and right ventricle (RV). Interatrial septum is intact. Direct connection (arrow, C, D, F) between left atrium (LA) and coronary sinus (asterisk, F) was identified and was confirmed on cardiac catheterization to be a defect in coronary sinus septum. LV = left ventricle.

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5D —65-year-old woman with history of breast cancer and persistent complaints of dyspnea. Still images from cine MRI four-chamber (C and D) and short-axis (E and F) views of heart show enlarged right atrium (RA) and right ventricle (RV). Interatrial septum is intact. Direct connection (arrow, C, D, F) between left atrium (LA) and coronary sinus (asterisk, F) was identified and was confirmed on cardiac catheterization to be a defect in coronary sinus septum. LV = left ventricle.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5E —65-year-old woman with history of breast cancer and persistent complaints of dyspnea. Still images from cine MRI four-chamber (C and D) and short-axis (E and F) views of heart show enlarged right atrium (RA) and right ventricle (RV). Interatrial septum is intact. Direct connection (arrow, C, D, F) between left atrium (LA) and coronary sinus (asterisk, F) was identified and was confirmed on cardiac catheterization to be a defect in coronary sinus septum. LV = left ventricle.

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5F —65-year-old woman with history of breast cancer and persistent complaints of dyspnea. Still images from cine MRI four-chamber (C and D) and short-axis (E and F) views of heart show enlarged right atrium (RA) and right ventricle (RV). Interatrial septum is intact. Direct connection (arrow, C, D, F) between left atrium (LA) and coronary sinus (asterisk, F) was identified and was confirmed on cardiac catheterization to be a defect in coronary sinus septum. LV = left ventricle.

View larger version (176K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —57-year-old man with persistent left superior vena cava. Four-chamber (A) and sagittal oblique (B) contrast-enhanced CT images of heart show presence of IV contrast material in left superior vena cava (LSVC). Coronary sinus (asterisk) is enlarged, and right atrium (RA) and right ventricle (RV) are normal size. LA = left atrium.

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —57-year-old man with persistent left superior vena cava. Four-chamber (A) and sagittal oblique (B) contrast-enhanced CT images of heart show presence of IV contrast material in left superior vena cava (LSVC). Coronary sinus (asterisk) is enlarged, and right atrium (RA) and right ventricle (RV) are normal size. LA = left atrium.

Partially Anomalous Pulmonary Venous Connections

Top Abstract Introduction Atrial Septal Anatomy and... Partially Anomalous Pulmonary... Coronary Artery Fistulas Tricuspid Valve Abnormalities Pulmonary Valve Myocardium Conclusion References

 
Partially anomalous pulmonary venous connections most commonly involve the right lung but may also involve the left lung [9]. The anomalous pulmonary veins can drain to systemic veins, including the coronary sinus, the left innominate vein, the hepatic veins, the superior vena cava, or a persistent left superior vena cava, or directly to the right atrium. In the spectrum of this disorder, patients may have one or many pulmonary veins draining to the systemic veins or directly to the right atrium. This extracardiac shunt can cause right atrial and right ventricular enlargement if a significant portion of blood is being shunted to the right atrium instead of the left atrium (i.e., if the atrial septum is intact) (Fig. 7A, 7B, 7C, 7D, 7E, 7F). Isolated lobar anomalous pulmonary venous drainage does not necessarily result in right heart chamber enlargement at initial presentation but may do so over time.

View larger version (68K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —47-year-old asymptomatic woman with partially anomalous pulmonary venous connection. Sequential axial contrast-enhanced images of chest show enlargement of right atrium (RA) and right ventricle (RV). There is abnormal drainage of right upper and right middle lobe pulmonary veins to superior vena cava (arrow, A-C) consistent with partially anomalous pulmonary venous connection. AA = ascending aorta, PA = pulmonary artery, LA = left atrium, LV = left ventricle.

View larger version (70K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —47-year-old asymptomatic woman with partially anomalous pulmonary venous connection. Sequential axial contrast-enhanced images of chest show enlargement of right atrium (RA) and right ventricle (RV). There is abnormal drainage of right upper and right middle lobe pulmonary veins to superior vena cava (arrow, A-C) consistent with partially anomalous pulmonary venous connection. AA = ascending aorta, PA = pulmonary artery, LA = left atrium, LV = left ventricle.

View larger version (67K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7C —47-year-old asymptomatic woman with partially anomalous pulmonary venous connection. Sequential axial contrast-enhanced images of chest show enlargement of right atrium (RA) and right ventricle (RV). There is abnormal drainage of right upper and right middle lobe pulmonary veins to superior vena cava (arrow, A-C) consistent with partially anomalous pulmonary venous connection. AA = ascending aorta, PA = pulmonary artery, LA = left atrium, LV = left ventricle.

View larger version (72K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7D —47-year-old asymptomatic woman with partially anomalous pulmonary venous connection. Sequential axial contrast-enhanced images of chest show enlargement of right atrium (RA) and right ventricle (RV). There is abnormal drainage of right upper and right middle lobe pulmonary veins to superior vena cava (arrow, A-C) consistent with partially anomalous pulmonary venous connection. AA = ascending aorta, PA = pulmonary artery, LA = left atrium, LV = left ventricle.

View larger version (72K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7E —47-year-old asymptomatic woman with partially anomalous pulmonary venous connection. Sequential axial contrast-enhanced images of chest show enlargement of right atrium (RA) and right ventricle (RV). There is abnormal drainage of right upper and right middle lobe pulmonary veins to superior vena cava (arrow, A-C) consistent with partially anomalous pulmonary venous connection. AA = ascending aorta, PA = pulmonary artery, LA = left atrium, LV = left ventricle.

View larger version (70K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7F —47-year-old asymptomatic woman with partially anomalous pulmonary venous connection. Sequential axial contrast-enhanced images of chest show enlargement of right atrium (RA) and right ventricle (RV). There is abnormal drainage of right upper and right middle lobe pulmonary veins to superior vena cava (arrow, A-C) consistent with partially anomalous pulmonary venous connection. AA = ascending aorta, PA = pulmonary artery, LA = left atrium, LV = left ventricle.

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8 —20-year-old woman with partially anomalous pulmonary venous return (scimitar syndrome). Posteroanterior chest radiograph shows small right hemithorax and small right hilum with abnormal curvilinear opacity that represents anomalous vein in right lower hemithorax (arrows) and dextroposition of heart due to hypoplastic right lung.

Top Abstract Introduction Atrial Septal Anatomy and... Partially Anomalous Pulmonary... Coronary Artery Fistulas Tricuspid Valve Abnormalities Pulmonary Valve Myocardium Conclusion References

View larger version (150K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A —69-year-old man with coronary artery-to-coronary sinus fistula. Axial ECG-gated CT images of heart show enlarged right atrium (RA). There is enlarged left main coronary artery connecting to large serpiginous left circumflex artery (arrow, B-D) that connects to coronary sinus (asterisk on oblique image, D). AA = ascending aorta, LA = left atrium, LV = left ventricle, RV = right ventricle.

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B —69-year-old man with coronary artery-to-coronary sinus fistula. Axial ECG-gated CT images of heart show enlarged right atrium (RA). There is enlarged left main coronary artery connecting to large serpiginous left circumflex artery (arrow, B-D) that connects to coronary sinus (asterisk on oblique image, D). AA = ascending aorta, LA = left atrium, LV = left ventricle, RV = right ventricle.

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9C —69-year-old man with coronary artery-to-coronary sinus fistula. Axial ECG-gated CT images of heart show enlarged right atrium (RA). There is enlarged left main coronary artery connecting to large serpiginous left circumflex artery (arrow, B-D) that connects to coronary sinus (asterisk on oblique image, D). AA = ascending aorta, LA = left atrium, LV = left ventricle, RV = right ventricle.

View larger version (182K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9D —69-year-old man with coronary artery-to-coronary sinus fistula. Axial ECG-gated CT images of heart show enlarged right atrium (RA). There is enlarged left main coronary artery connecting to large serpiginous left circumflex artery (arrow, B-D) that connects to coronary sinus (asterisk on oblique image, D). AA = ascending aorta, LA = left atrium, LV = left ventricle, RV = right ventricle.

Top Abstract Introduction Atrial Septal Anatomy and... Partially Anomalous Pulmonary... Coronary Artery Fistulas Tricuspid Valve Abnormalities Pulmonary Valve Myocardium Conclusion References

View larger version (168K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10A —8-year-old noncyanotic boy with history of tricuspid valve dysplasia. Posteroanterior (A) and lateral (B) chest radiographs show markedly enlarged right atrium (asterisk, A) and right ventricle (arrow, B). Pulmonary vascularity is normal.

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10B —8-year-old noncyanotic boy with history of tricuspid valve dysplasia. Posteroanterior (A) and lateral (B) chest radiographs show markedly enlarged right atrium (asterisk, A) and right ventricle (arrow, B). Pulmonary vascularity is normal.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11A —30-year-old man with Ebstein's anomaly. Still images from cine MRI short-axis (A and B) and long-axis (C and D) views of heart in systole and diastole show enlarged right atrium and right ventricle (RV) with apical displacement of septal tricuspid leaflet (arrowhead, C). Anterior leaflet (arrow, C and D) is elongated and sail-like.

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11B —30-year-old man with Ebstein's anomaly. Still images from cine MRI short-axis (A and B) and long-axis (C and D) views of heart in systole and diastole show enlarged right atrium and right ventricle (RV) with apical displacement of septal tricuspid leaflet (arrowhead, C). Anterior leaflet (arrow, C and D) is elongated and sail-like.

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11C —30-year-old man with Ebstein's anomaly. Still images from cine MRI short-axis (A and B) and long-axis (C and D) views of heart in systole and diastole show enlarged right atrium and right ventricle (RV) with apical displacement of septal tricuspid leaflet (arrowhead, C). Anterior leaflet (arrow, C and D) is elongated and sail-like.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11D —30-year-old man with Ebstein's anomaly. Still images from cine MRI short-axis (A and B) and long-axis (C and D) views of heart in systole and diastole show enlarged right atrium and right ventricle (RV) with apical displacement of septal tricuspid leaflet (arrowhead, C). Anterior leaflet (arrow, C and D) is elongated and sail-like.

Top Abstract Introduction Atrial Septal Anatomy and... Partially Anomalous Pulmonary... Coronary Artery Fistulas Tricuspid Valve Abnormalities Pulmonary Valve Myocardium Conclusion References

View larger version (154K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12A —47-year-old man who underwent repair of tetralogy of Fallot at age of 6 years. Posteroanterior (A) and lateral (B) chest radiographs show enlargement of right atrium (asterisk, A), right ventricle (arrow, B), and left pulmonary artery (arrowhead, A).

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12B —47-year-old man who underwent repair of tetralogy of Fallot at age of 6 years. Posteroanterior (A) and lateral (B) chest radiographs show enlargement of right atrium (asterisk, A), right ventricle (arrow, B), and left pulmonary artery (arrowhead, A).

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12C —47-year-old man who underwent repair of tetralogy of Fallot at age of 6 years. Still images from cine MRI long-axis views of heart show enlarged right atrium (RA) and right ventricle (RV) with severe pulmonary valve insufficiency jet (arrow, D). PA = pulmonary artery.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12D —47-year-old man who underwent repair of tetralogy of Fallot at age of 6 years. Still images from cine MRI long-axis views of heart show enlarged right atrium (RA) and right ventricle (RV) with severe pulmonary valve insufficiency jet (arrow, D). PA = pulmonary artery.

Top Abstract Introduction Atrial Septal Anatomy and... Partially Anomalous Pulmonary... Coronary Artery Fistulas Tricuspid Valve Abnormalities Pulmonary Valve Myocardium Conclusion References

View larger version (104K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13A —60-year-old man with recurrent right ventricular tachycardia. Still images from cine MRI short-axis (A) and long-axis (B) views of heart in systole show enlargement of right ventricle (RV) with focal aneurysm (arrow, B) consistent with diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy. LV = left ventricle.

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13B —60-year-old man with recurrent right ventricular tachycardia. Still images from cine MRI short-axis (A) and long-axis (B) views of heart in systole show enlargement of right ventricle (RV) with focal aneurysm (arrow, B) consistent with diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy. LV = left ventricle.

Top Abstract Introduction Atrial Septal Anatomy and... Partially Anomalous Pulmonary... Coronary Artery Fistulas Tricuspid Valve Abnormalities Pulmonary Valve Myocardium Conclusion References

Acknowledgments
 
We thank the artist Michael Stevens for his drawing of the atrial septum shown in Figure 1.

References

Top Abstract Introduction Atrial Septal Anatomy and... Partially Anomalous Pulmonary... Coronary Artery Fistulas Tricuspid Valve Abnormalities Pulmonary Valve Myocardium Conclusion References

 

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This Article Abstract Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cook, A. L. Articles by Herlong, J. R. Search for Related Content PubMed PubMed Citation Articles by Cook, A. L. Articles by Herlong, J. R. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?